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2006 Georgia Code - 21-4-9
21-4-9. (a) At any time prior to the date an application for recall petition or a recall petition is filed for verification, an elector who has signed the application or the recall petition form may request withdrawal of his or her signature from the application or recall petition by executing and filing an affidavit, in the form prescribed by this Code section, with the election superintendent. Any signature so withdrawn shall not be counted in determining the legal sufficiency of the application or recall petition. The affidavit shall: (1) Be signed and sworn to before a notary public; (2) State the electoŕs residence address, giving number and street or route and city, the name of the county of residence, and, in the case of a recall application or petition, the number of the recall application or petition which he or she signed; and (3) Affirm the electoŕs intention to withdraw his or her signature from the application or recall petition. (b) The affidavit shall be substantially in the following form:AFFIDAVIT OF SIGNATURE WITHDRAWAL
State of Georgia
County of ______________
I, _______________________ (Name as it appears on the application or recall petition), being first duly sworn, say that I am an elector of the ______________ (electoral district) in which the recall election will be conducted. That my residence address is ______________________________________________ ______________________________________________________________________ (Number and street or route) (City) That I signed or caused to be signed the application or the petition for the recall of _______________________ (Name and office of person sought to be recalled) and that the recall application or petition has been assigned number ______________. That it is my intention by the signing and filing of this affidavit to withdraw my signature therefrom.
____________________
Signature of elector
Subscribed and sworn to
before me this ______
day of ______________, ____.
_________________
Notary public
__________, Georgia My commission expires on the ______ day of ______________, ____.
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